癸巳秋仲，南都大司马袁洪溪老先生，以兼署工部都察院，操江印日，冲暑往来各衙
门，
而经络其政事，致发热燥渴。因解燥渴，而过食水浸瓜梨新藕，遂成泄泻，小水短少。医以
胃苓汤加滑石、木通、车前子利之而泻止。大便又因之结燥，艰涩不堪。乃用润肠丸，复泻
不止。又进以前通利之剂，泻虽止而小水竟不得流通直遂，脐下胀急。立起解之，则点滴不
出，卧则流之不竭，以频取夜壶，致通宵不得寐也。治半月余，而精神削，寝食废。闻予寓
崔勋部衙，而征予治。初见即告以受病之源，又谓都城诸医俱不识为何症。将认为癃，则立
解时点滴不出；认为秘，卧则涓涓而流；谓为脾约，大便又不结燥；谓气虚下陷，心血不足
，而补中益气汤与安神丸，服过十昼夜无益。雅闻先生高手，愿一诊以决之。探其脉，两寸
短弱，关缓大，两尺洪大。语之曰∶此余暑未解，而司马素善饮，湿热流于下部也。今已下
午，恐诊之未准，俟明早细察而再定方。公曰∶延颈吾子久矣，适所言近似，愿亟求一剂饮
之，侥夜间一睡。予不得已，以益元散三钱，煎香薷汤进之，略无进退。次早复诊，六脉如
昨。予思之而恍然悟。又语之曰∶此症尿窍不对也。司马曰∶名出何书？予曰∶《内经》云
∶膀胱者，脬之室也。脬中湿热下坠，故立解而窍不对，小水因不得出，卧则脬不下坠，而
尿渗出膀胱。亦以窍不对，小水虽涓涓而流，亦不能通达直遂，故了而不了也。治惟提补上
中二焦元气，兼清下焦湿热，斯得矣。又有一法，今气虚下陷已久，一两剂未能取效，安得
伏枕而睡？且此不寐，非心血不足之故，因着心防闲小便之了而不了而不敢寐也。暂将旧衣
或布衬于席上，不必防而任其流出，又免取夜器而劳动其神，自然熟睡矣。以补中益气汤提
补上中二焦之元气，加黄柏、知母、祛下焦之
湿热，夫清阳升则浊阴自降，脬无湿热则不下坠，窍可对而病可瘳矣。司马忻然请药，夜
如
法衬之，果嗒然一睡，相忘其尿之出不出也。次早视衬布，虽湿而不甚。以久不阖目，得此
一睡，神气顿回，胸臆爽快如未病者。调理四日而病全安。司马大喜，而欲留久住，缘漕运
李公相延之亟，勿克也。差大马舡，鼓吹送予阡关而还。
癸巳年仲秋，南京大司马袁洪溪老先生，因兼任工部都察院及操江印务，每日顶着酷暑在各衙门间奔波，处理政务，导致发热、口干舌燥且极度口渴。为了缓解燥渴，他过量食用了用水浸泡过的西瓜、梨子和新鲜莲藕，于是引发了腹泻，小便短少。医生用胃苓汤加入滑石、木通、车前子进行利水渗湿治疗，腹泻虽然停止了，但大便因此变得干结，排便困难痛苦不堪。接着使用了润肠丸，结果反而导致腹泻不止。又服用了之前的通利药物，腹泻虽止，但小便完全无法通畅排出，脐下部位胀满急迫。站立时想解小便，却点滴不出；躺下时尿液却流个不停，因为频繁起来取夜壶，导致整夜无法入睡。经过半个多月的治疗，患者精神消瘦，寝食难安。听说我住在崔勋部的衙署附近，便请我去诊治。初见时，我便告知他发病的根源，并说京城的各位医生都不清楚这是什么病症。如果认为是癃闭（小便不通），那么站立时应该点滴不出；如果是秘结（大便不通），躺下时也不应有尿液流出；如果认为是脾约（脾虚便秘），大便又不干结；如果认为是气虚下陷、心血不足，那么服用补中益气汤和安神丸十昼夜也没有效果。大家久仰先生医术高明，希望诊脉以决断病情。我探按其脉搏，两寸脉短弱，关脉缓大，两尺脉洪大。我对他说：“这是余热未清，加上司马大人平时喜欢饮酒，湿热之邪流注于下部所致。现在已经下午了，恐怕诊断不够准确，等到明天早上仔细观察后再定方药。”袁公说：“我盼望您的诊治已经很久了，刚才所说的话很接近实情，希望能尽快开一剂药喝下，侥幸能睡个好觉。”我不得已，开了益元散三钱，用香薷汤煎服，服药后症状没有明显进退变化。第二天早上复诊，六脉如昨日一样。我思考后恍然大悟，又对他说：“这个病症是尿窍位置不对。”司马问：“这话出自哪本书？”我说：“《内经》说：膀胱是胞室的所在。胞中的湿热下坠，所以站立时尿窍位置不正，小便因此排不出；躺下时胞室不下坠，尿液渗出膀胱。也是因为尿窍位置不正，小便虽然涓涓流出，但不能通达顺畅，所以感觉解了却没解干净。治疗只有提补上、中二焦的元气，兼清下焦的湿热，才能痊愈。还有一个办法，现在气虚下陷已久，一两剂药难以见效，怎么能让您躺在床上睡着呢？而且这种失眠，不是因为心血不足，而是因为担心小便解不干净而不敢睡觉。暂时在席子上铺旧衣服或布衬垫，不必担心，任由尿液流出，这样也免去了取夜壶惊扰心神，自然就能熟睡了。”我用补中益气汤提补上、中二焦的元气，加入黄柏、知母以祛除下焦的湿热，清阳上升则浊阴自降，胞中没有湿热就不会下坠，尿窍就能对正，病就能好了。司马欣然求药，晚上按方法铺垫，果然酣然入睡，忘记了小便是否流出。第二天早上查看衬布，虽然湿了但不严重。因为长久没合眼，得到这一觉，神气顿时恢复，胸膈爽快如同没生病的人。调理四天后病全愈。司马非常高兴，想让我久住，但因为漕运李公急切邀请，未能成行。派大船，吹鼓手护送我至阡关返回。
In the middle of autumn in the Gui Si year, Grand Marshal Yuan Hongxi of Nanjing, who concurrently held the positions of Minister of Works, Censorate, and Commander of the River Operations, traveled daily between various government offices under the scorching sun to handle official duties. This led to fever, dry mouth, and extreme thirst. To relieve the dryness and thirst, he consumed excessive amounts of water-soaked watermelon, pear, and fresh lotus root, which subsequently caused diarrhea and scanty urination. Physicians treated him with Weiling Tang (Stomach and Lingzhi Decoction) added with Huashi (Talcum), Mutong (Akebia Stem), and Cheqianzi (Plantago Seed) to promote diuresis, which stopped the diarrhea. However, this resulted in dry and hard stools, making defecation extremely difficult. Subsequently, Runchang Wan (Moisten Intestines Pill) was administered, but this exacerbated the condition, leading to persistent diarrhea. Previous purgative and diuretic agents were tried again; while the diarrhea ceased, urination became completely obstructed, causing distension and urgency below the umbilicus. When standing to urinate, not a drop could be passed; when lying down, urine flowed incessantly. Due to the frequent need to empty the chamber pot, he suffered from insomnia throughout the night. After more than half a month of treatment, his spirit declined, and both sleep and appetite were lost. Hearing that I resided in the office of Department Minister Cui, he summoned me for treatment. Upon first meeting, I informed him of the origin of his illness and stated that the physicians in the capital did not recognize the syndrome. If it were considered Long Bi (obstructive urinary dysfunction), urine should not flow when lying down; if considered Mi Jie (constipation), there would be no urine leakage; if considered Pi Yue (spleen constraint constipation), the stool would not be dry; if considered Qi Xu Xia Xian (Qi deficiency with sinking) and Xin Xue Bu Zu (Heart blood insufficiency), then Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Anshen Wan (Calm the Spirit Pill) taken for ten days and nights should have been effective. Having heard of your high medical skill, we hope you will diagnose us to resolve the matter. I palpated his pulse: the Cun (inch) positions on both sides were short and weak, the Guan (bar) positions were slow and large, and the Chi (cubit) positions were surging and large. I said to him, "This is residual summerheat unresolved, combined with your habit of drinking alcohol, leading to damp-heat flowing into the lower jiao. It is now afternoon, so my diagnosis may not be precise yet. I will wait until tomorrow morning to examine you carefully before prescribing." The Duke said, "I have long awaited your arrival. What you said is quite accurate. I wish to take a dose immediately to hopefully get some sleep." Reluctantly, I prescribed Yi Yuan San (Benefit Primordial Powder) three qian, decocted in Xiangru Tang (Mosla Decoction). There was little change in symptoms. On the next morning's follow-up, the six pulses remained the same. I pondered and suddenly realized. I told him again, "This syndrome is due to misalignment of the urethral orifice." The Duke asked, "Which book does this term come from?" I replied, "The Nei Jing states: 'The bladder is the chamber of the paodang (urinary bladder/uterus).' Damp-heat in the paodang sinks downward, so when standing, the orifice is misaligned, preventing urination; when lying down, the paodang does not sink, allowing urine to seep out. Because the orifice is still misaligned, although urine flows in drops, it cannot drain smoothly, hence the sensation of incomplete emptying. Treatment requires tonifying the Yuan Qi of the upper and middle jiao, while simultaneously clearing damp-heat from the lower jiao. Another method: since Qi deficiency with sinking has persisted for a long time, one or two doses will not suffice to make you lie down and sleep. Moreover, this insomnia is not due to Heart blood insufficiency, but rather the fear of incomplete emptying prevents sleep. Temporarily line your mat with old clothes or cloth pads. Do not worry; let the urine flow freely. This avoids disturbing the Shen (spirit) by getting up to use the chamber pot, allowing natural deep sleep." I used Buzhong Yiqi Tang to tonify the Yuan Qi of the upper and middle jiao, adding Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to clear damp-heat from the lower jiao. As clear Yang ascends, turbid Yin naturally descends; without damp-heat in the paodang, it will not sag, the orifice will align, and the disease will heal. The Duke happily accepted the prescription. That night, following the advice to pad the bed, he indeed slept soundly, forgetting whether urine had flowed or not. The next morning, the padding was moist but not soaked. Having not closed his eyes for so long, this sleep restored his Shen Qi instantly, and his chest felt refreshed as if he were healthy. After four days of regulation, he fully recovered. The Duke was overjoyed and wished to keep me staying longer, but due to the urgent invitation from Li Gong of the Grain Transport, I could not stay. A large boat was dispatched, with musicians escorting me back to Qian Pass.